title: Replacement of reduced highly unsaturated fatty acids (HUFA deficiency) in dilative heart failure: dosage of EPA/DHA and variability of adverse peroxides and aldehydes in dietary supplement fish oils.
abstract: OBJECTIVE
  To explore the rationale for ω-3 fatty acids in heart failure treatment, the dosage of EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) for replacing low levels of highly unsaturated fatty acids (HUFA deficiency) was examined. To judge the usefulness of various EPA/DHA preparations, their content of peroxides and aldehydes was determined.
  
  
  METHODS
  In 298 patients with dilative heart failure, the serum HUFA level was assessed by gas chromatography. In ω-3-acid ethyl esters 90 (Omacor/Lovaza, approved by the Food and Drug Administration and the European Medicines Agency) and 63 dietary supplement fish oils, oxidation products were determined by photometry.
  
  
  RESULTS
  Increasing serum HUFA from the lower (4.3 ± 1.0%) to the upper (9.5 ± 1.5%) tertile would be associated with an increased left ventricular (LV) ejection fraction (34.1 ± 9.9 vs. 28.3 ± 9.5%, p < 0.01) and reduced LV enddiastolic diameter (63.5 ± 7.1 vs. 66.9 ± 7.4 mm) requiring at least 2 g EPA/DHA daily. In fish oils, the peroxide and alkenal level varied greatly, i.e. peroxide value ≤ 5 mEq/kg in only 7 and ≤ 10 mEq/kg in 38 fish oils. Compared with equivalent doses of ω-3-acid ethyl esters 90, the mean peroxide intake would be 8.6 ± 6.1 and the alkenal intake 10.9 ± 4.4 times higher in fish oils.
  
  
  CONCLUSIONS
  Levels of adverse oxidation products should be considered when targeting HUFA deficiency or treating patients with myocardial infarction or high triglycerides.
authors.affiliation: Department of Internal Medicine-Cardiology, Philipps University, Marburg, Germany.
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Rupp
authors.forename: Karin G
authors.initials: KG
authors.lastname: Rupp
authors.forename: Peter
authors.initials: P
authors.lastname: Alter
authors.forename: Heinz
authors.initials: H
authors.lastname: Rupp
mesh_terms: D000447:Aldehydes / Q000032:analysis; D002311:Cardiomyopathy, Dilated / Q000178:diet therapy; D002316:Cardiotonic Agents / Q000008:administration & dosage*; D019587:Dietary Supplements; D004281:Docosahexaenoic Acids / Q000008:administration & dosage*; D015118:Eicosapentaenoic Acid / Q000008:administration & dosage*; D005231:Fatty Acids, Unsaturated / Q000097:blood / Q000172:deficiency*; D005395:Fish Oils / Q000008:administration & dosage* / Q000737:chemistry; D006333:Heart Failure / Q000175:diagnosis / Q000178:diet therapy*; D006801:Humans; D015228:Hypertriglyceridemia / Q000097:blood / Q000628:therapy; D009203:Myocardial Infarction / Q000097:blood / Q000628:therapy; D016877:Oxidants / Q000378:metabolism; D010545:Peroxides / Q000032:analysis; D012372:ROC Curve; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis
chemical_list: D000447:Aldehydes; D002316:Cardiotonic Agents; D005231:Fatty Acids, Unsaturated; D005395:Fish Oils; D016877:Oxidants; D010545:Peroxides; D004281:Docosahexaenoic Acids; D015118:Eicosapentaenoic Acid